Organization
SAN MARCOS MEDICAL IMAGING PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY C. DE LA IGLESIA MD (PRESIDENT)
(512) 396-8565
Entity
Organization
Contact information
Practice address
1301 WONDER WORLD DR, SAN MARCOS, TX 78666-7533
(512) 396-8565
(512) 396-8567
Mailing address
PO BOX 1005, SAN MARCOS, TX 78667-1005
(512) 396-8565
(512) 396-8567
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
H7991
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00TS99
BCBS
TX
05
—
103672502
—
TX
01
—
83R493
MEDICARE
TX
Enumeration date
03/23/2007
Last updated
06/16/2017
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